Proof of Service SubstitutedCal. Super. - 6th Dist.March 2, 2020‘ ' \ Clerk stamps date here when form is filed SC-104 Proof of Servuce . ‘ - E E EUse this form t0 serve a person, a business, or a public entity. T0 learn more about proof of service, read WhatIs 'ProofofSen’ice”?, Fonn SC-104B. To learn more about how to serve a business or entity, read How t0 Sen‘e a Business or Public Entity Form SC- 104C To serve a business, you must sérve one 0f the following people: - Owner (for a sole proprietorship) ° Partner (for a pannership) or general partner (for a limited pafinershipa -A.ny officer 0r general manager (corporation 0r association) : - Any person authorized for service by the business (corporation, association, general partnership, limited partnership) Fill in court name and street address: - Any person authorized for service with the Secretary of State (corporation, SUPe'im’ Court 0f calif‘m‘ia’ COUMY 0f association, limited liability company [LLC], limited liability partnership Superior Courtcwfl Division [LLP], limited partnership) > 191 N. First St. To serve a public entity, you must first file a Claim with that entity, then San Jose. CA 95113 serve one of the following people: ' Clerk (ofa city 0r county) . Chief Officer 0r director (of a public agency) Fill in _E:ase number, case name, hearing dare, - An erson authorized for service b the entity day' Ume’ and department bmw‘l yp If _ y ,t th , b 1 Case Number: a. 0u are servm a erson wrl e e erson s name e 0w: . . kG) Y g P ’ P zoscoszvag AARON 90077” (MP; EET b. If you are serving a business or entity, write the name 0f the business or entity, the person authorized for service, and that pqrson’s job title: J Case Name: 4 Hearing Date: Business orAgency Name q Z L! 2 O Person Audiorized for Service Job Title Time: 5 ‘ ‘7’)0 Rm Dept: {g® instructions to Server: You must be at least 18 years 01d and not be named in this case. Follow these steps: - Give a copy of all the documents checked in® to the person in ®, 0r - Give a copy 0f all the documents checked in® to one of the following people: a. A competent adult (at least 18) living with, and at the home 0f the person in G), 0r b. An adult (at least 18) who seems t0 be in charge at the usual workplace ofthe person in (D, 0r c. An adult (at least 18) who seems t0 be in charge where the person in ®usually receives mail (but not a U.S. Post Office box), if there is no known physical address for the person i116) and mail a copy 0fthe documents lefi with one of the adults in a, b, or c above to the person in®. THEN - Complete and sign this form, and - Give or mail your completed form to the person who asked you to serve these court papers, in timefor theform to beflled with the court at least 5 days before the hearing. © | served the person in ® a copy of the documents checked below: a. SC-IOO, Plairztz'fl'sfi'lgz‘m and ORDER t0 G0 to Small Claims Court £b D SC- 120, Defendant'srClaim and ORDER t0 G0 20 Small Claims Court 4w c D Order for examination (Uzisform 'must be personally served Check theform that was served). Note. The court can issue a civil arre'st ivarran! iftlze servedpmty does not come to court only ifthe orderfor eramination was personally served by a regismredprocess server, sherifl marshal, 0) someone appomted by the calm. (1) D SC- 1'34, Application and Order t0 Produce Statemen! ofAssets and t0 Appearfor Examination (23 D AT-138fEJ-125, Application and Orderfor Appearance and Examination d. D Other (specify): Judicaa‘oounduofcamomia. m.goummocagov proof of Service SC-1 04, Page 1 0-32Revised January 1. 2009. Optional Faun _ Code of Civil Procedure. §§ 116,340. 415.10, 415.20 (S mall Clalms) Case Number: Case name: ® Fill out “a" or “b" below: ,>, a. D Personal Service: Ipersonally gave copies of the documents checked in© to the person i116): On (date): ------- At (time):-- D a.m. D p.m. At this address: City: State' Zip: b. E(Subsfituted Service: I personally gave copies of the documents checked in© (a, b, 0r d) to (check one): A competent adult (at least 18) at the home of, and living with the person in® , 0r D An adult who seems to be in charge where the person in® usually works, or D An adult who seems to be in charge where the erson in usually receives mail, or has a rivateP P post office box (not a U.S. Post Office box), ifthere is no known physical address for the person in®. .._5 I told that adult, “Please give these court papers to (name of person in©." Ididthis on (date): fiuqusT 20., 7-0 10 At(time): l ~' IO D am. E/pm. J Atthisaddress: ‘8 IO Palm (3+ 9n jogo C City: 54/1 3356» State: C9 Zip: CVSHO _> Name or descrigti‘on of the person I gave the papers to: 7056 [PM After serving the court papers, I put copies of the documents listed in© in an envelope, sealed the envelope, and put first-class Ereggid postqge on it. I addressed the envelope t0 the person in® at the address where I left the copies. Imailed the envelope on (date): g ’zq 2020 from (city. stare): SGHSID 5 ,. afl by leaving il (check one): a. At a U.S. Postal Service mail drop, or b. D At an office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, or - 0D With someone else I asked to mail the documents to the person in @, and I have attached that person’s completed Form SC-104A. © Server’s Information Name; R L'aar‘ai o Lapez Phone: 37> \~’ 7,3 Y-fi 61 33 Address= H022W'% m unrns S’r City: So (QGLAd State:CA' Zip: flag (00 Fee for service: $ Ifyou m‘e a registered process server: county 0f rEgiStrationi Registration number: ® [declare under penalty ofpetjury under California state law that I am at least 18 years old a 0t named in this case and that the information above is true and correct. Date: . Type orpn'm server ’s name I 5'6ng her? afler serving RevisedJanuary 1.2009 proof of service V SC-1 D4. Page 2 of 2 (Small Claims)
